J Korean Med Assoc Search

CLOSE


J Korean Med Assoc > Volume 52(7); 2009 > Article
Yim, Lee, Park, and Kim: Differential Diagnosis and Management of Abnormal Posture of the Head and Neck

Abstract

Abnormal posture of the head and neck can happen to anybody from neonates to adults, which requires appropriate interventions according to etiologies. Congenital muscular torticollis is the most common cause of abnormal posture of the head and neck in infancy, where early intervention as soon as possible is critical for better therapeutic outcome. Childhood laterocollis is heterogeneous condition, which needs etiological diagnosis for the proper management. Cervical dystonia is the most common form of focal dystonia and an overview on clinical presentations and therapeutic options including chemodenervation with botulinum toxin injection was provided. Abnormal posture of the head and neck of acute onset could be a sign of serious conditions and needs differential diagnosis.

Figure 1.
Abnormal posture of the head and neck. (A) Left torticollis, (B) Right laterocollis, (C) Anterocollis, (D) Retrocollis.
jkma-52-705f1-l.jpg
Figure 2.
A 10 month-old girl who has right congenital muscular torticollis. (A) Unilateral palpable neck mass of muscle-consistency on right sternocleidomastoid muscle. (B) and (C) Neck MRI findings showing large mass of right sternocleidomastoid muscle.
jkma-52-705f2-l.jpg
Figure 3.
Children who have left congenital muscular torticollis which have thick and short left sternocleidomastoid muscle, ending up with right torticollis and left laterocollis.
jkma-52-705f3-l.jpg
Figure 4.
(A) Relations between the sternocleidomastoid muscle (SCM) and the internal branch of the superior laryngeal nerve (ibSLN). (B) Relations between the ibSLN and the other anatomic structures. ECA external carotid artery, SLA superior laryngeal artery Adapted from Kiray A, Naderi S, Ergur?, Korman E. Surgical anatomy of the internal branch of the superior laryngeal nerve. Eur Spine J 2006; 15: 1320-1325 with kind permission of Springer Science + Business Media.
jkma-52-705f4-l.jpg
Figure 5.
Three-dimensional CT showing left plagiocephaly associated with left congenital muscular torticollis.
jkma-52-705f5-l.jpg
Figure 6.
A diagram showing spontaneous compensation for torticollis by (A) elevation of the shoulder on the affected side or by (B) production of cervical scoliosis with two curves.
jkma-52-705f6-l.jpg
Figure 7.
The ultrasonographic findings of the sternocleidomastoid muscle for the children who had congenital muscular torticollis (CMT).
jkma-52-705f7-l.jpg
Figure 8.
Histologic findings of the sternocleidomastoid muscle with congenital muscular torticollis. (A) Diffuse fibroblastic proliferation with fibrosis and accompanying atrophic muscle fibers. H&E;x100. (B) Irregular arrangement of fibrous trabeculae, mature adipose cells and muscle fibers. H&E;x100.
jkma-52-705f8-l.jpg
Figure 9.
Ajou therapeutic protocol for children with congenital muscular torticollis at the age of 3 months or younger.
jkma-52-705f9-l.jpg
Figure 10.
The boys who show (A) right laterocollis and (B) left laterocollis.
jkma-52-705f10-l.jpg
Figure 11.
Differential diagnosis of abnormal posture of the head and neck in children.
jkma-52-705f11-l.jpg
Figure 12.
The biosynthetic pathway of tetrahydrobiopterin and dopa from guanosine triphosphate (GTP). GCH 1:GTP cyclohydrolase I, Phe: phenylalanine, Try: tyrosine.
jkma-52-705f12-l.jpg
Table 1.
Doses and muscles to inject as first line therapy, as well as maximum does, depending on the type of cervical dystonia
Type of cervical dystonia Muscles to be injected Dose at the first injection
Maximum dose
Botox® Dysport® Botox® Dysport®
Torticollis Ipsilateral splenius capitis and sternocleidomastoid 50∼80 150∼240 150 450
Laterocollis Trapezius and/or iIpsilateral levator scapulae and/or sternocleidomastoid and/or scalene 25∼30 75∼90 60 180
30∼60 90∼180 70∼80 210∼240
30∼60 90∼180 60∼70 180∼210
30∼40 90∼120 60 180
30∼40 90∼120 50 150
Retrocollis Bilateral splenius capitis 70∼100/70∼100 210∼300/210∼300 150/150 450/450
Anterocollis Bilateral sternocleidomastoid 25∼30/25∼30 75∼90/75∼90 40/40 120/120

Adapted from Ranoux D. Cervical dystonia. In: Ranoux D, Gury C, eds. Practical handbook on botulinum toxin. Marseile, France: Solal, 2007: 35-50 (32).

References

1. Cheng JC, Metreweli C, Chen TM, Tang S. Correlation of ultrasonographic imaging of congenital muscular torticollis with clinical assessment in infants. Ultrasound Med Biol 2000;26:1237-1241.
crossref pmid
2. Cheng JC, Tang SP, Chen TM, Wong MW, Wong EM. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants-a study of 1,086 cases. J Pediatr Surg 2000;35:1091-1096.
crossref pmid
3. Chen MM, Chang HC, Hsieh CF, Yen MF, Chen TH. Predictive model for congenital muscular torticollis: analysis of 1021 infants with sonography. Arch Phys Med Rehabil 2005;86:2199-2203.
crossref pmid
4. Dudkiewicz I, Ganel A, Blankstein A. Congenital muscular torticollis in infants: ultrasound-assisted diagnosis and evaluation. J Pediatr Orthop 2005;25:812-814.
crossref pmid
5. Sonmez K, Turkyilmaz Z, Demirogullari B, Ozen IO, Karabulut R, Bagbanci B, Basaklar AC, Kale N. Congenital muscular torticollis in children. ORL J Otorhinolaryngol Relat Spec 2005;67:344-347.
crossref pmid pdf
6. Do TT. Congenital muscular torticollis: current concepts and review of treatment. Curr Opin Pediatr 2006;18:26-29.
pmid
7. Tatli B, Aydinli N, Caliskan M, Ozmen M, Bilir F, Acar G. Congenital muscular torticollis: evaluation and classification. Pediatr Neurol 2006;34:41-44.
pmid
8. Cheng JC, Au AW. Infantile torticollis: a review of 624 cases. J Pediatr Orthop 1994;14:802-808.
pmid
9. Cheng JC, Tang SP, Chen TM. Sternocleidomastoid pseudotumor and congenital muscular torticollis in infants: a prospective study of 510 cases. J Pediatr 1999;134:712-716.
crossref pmid
10. Friedman M, LoSavio P, Ibrahim H. Superior laryngeal nerve identification and preservation in thyroidectomy. Arch Otolaryngol Head Neck Surg 2002;128:296-303.
crossref pmid
11. Kiray A, Naderi S, Ergur I, Korman E. Surgical anatomy of the internal branch of the superior laryngeal nerve. Eur Spine J 2006;15:1320-1325.
crossref pmid pmc pdf
12. Reynolds SM, Mackenzie AJ, Spina D, Page CP. The pharmacology of cough. Trends Pharmacol Sci 2004;25:569-576.
crossref pmid
13. Thompson F, McManus S, Colville J. Familial congenital muscular torticollis: case report and review of the literature. Clin Orthop Relat Res 1986;193-196.

14. Davids JR, Wenger DR, Mubarak SJ. Congenital muscular torticollis: sequela of intrauterine or perinatal compartment syndrome. J Pediatr Orthop 1993;13:141-147.
pmid
15. Yu CC, Wong FH, Lo LJ, Chen YR. Craniofacial deformity in patients with uncorrected congenital muscular torticollis: an assessment from three-dimensional computed tomography imaging. Plast Reconstr Surg 2004;113:24-33.
crossref pmid
16. Park MC, Song HS, Kim CS, Yim SY, Park DH, Pae NS, Lee IJ. Treatment of congenital muscular torticollis with unipolar release. J Korean Soc Plast Reconstr Surg 2009;35:38-45.

17. Oleszek JL, Chang N, Apkon SD, Wilson PE. Botulinum toxin type a in the treatment of children with congenital muscular torticollis. Am J Phys Med Rehabil 2005;84:813-816.
crossref pmid
18. Collins A, Jankovic J. Botulinum toxin injection for congenital muscular torticollis presenting in children and adults. Neurology 2006;67:1083-1085.
crossref pmid
19. Singh A, Wacogne I. What is the role of helmet therapy in positional plagiocephaly? Arch Dis Child 2008;93:807-809.
crossref pmid
20. Lee RP, Teichgraeber JF, Baumgartner JE, Waller AL, English JD, Lasky RE, Miller CC, Gateno J, Xia JJ. Long-term treatment effectiveness of molding helmet therapy in the correction of posterior deformational plagiocephaly: a five-year follow-up. Cleft Palate Craniofac J 2008;45:240-245.
crossref pmid pdf
21. Raman S, Takhtani D, Wallace EC. Congenital torticollis caused by unilateral absence of the sternocleidomastoid muscle. Pediatr Radiol 2009;39:77-79.
crossref pmid pdf
22. Williams CR, O'Flynn E, Clarke NM, Morris RJ. Torticollis secondary to ocular pathology. J Bone Joint Surg Br 1996;78:620-624.
crossref pmid pdf
23. Madigan WP, Zein WM. Recent developments in the field of superior oblique palsies. Curr Opin Ophthalmol 2008;19:379-383.
crossref pmid
24. Quartarone A, Rizzo V, Morgante F. Clinical features of dystonia: a pathophysiological revisitation. Curr Opin Neurol 2008;21:484-490.
crossref pmid
25. Benecke R, Dressler D. Botulinum toxin treatment of axial and cervical dystonia. Disabil Rehabil 2007;29:1769-1777.
crossref pmid
26. Stacy M. Epidemiology, clinical presentation, and diagnosis of cervical dystonia. Neurol Clin 2008;26(Suppl 1):23-42.
crossref pmid
27. Jankovic J, Tsui J, Bergeron C. Prevalence of cervical dystonia and spasmodic torticollis in the United States general population. Parkinsonism Relat Disord 2007;13:411-416.
crossref pmid
28. Lee CS, Lee CS, Chung SJ, Chung SJ, Im JH, Im JH, Lee MC, Lee MC, Yoo HW, Yoo HW. The DYT1 Gene Mutation in Primary Torsion Dystonia without Familial Background. J Korean Neurol Assoc 2003;21:169-173.

29. Nishiyama N, Yukishita S, Hagiwara H, Kakimoto S, Nomura Y, Segawa M. Gene mutation in hereditary progressive dystonia with marked diurnal fluctuation (HPD), strictly defined dopa-responsive dystonia. Brain Dev 2000;22(Suppl 1):S102-106.
crossref pmid
30. Adam OR, Jankovic J. Treatment of dystonia. Parkinsonism Relat Disord 2007;13(Suppl 3):S362-368.
crossref pmid
31. Jankovic J. Treatment of dystonia. Lancet Neurol 2006;5:864-872.
crossref pmid
32. Ranoux D. Cervical dystonia. In: Ranoux D, Gury C, eds. Practical handbook on botulinum toxin. Marseile, France: 33. Agrawal A, Cincu R, Joharapurkar SR, Bhake A, Hiwale KM. Hemorrhage in brain stem cavernoma presenting with torticollis. Pediatr Neurosurg 2009;45:49-52.
crossref pmid pdf
34. Hicazi A, Acaroglu E, Alanay A, Yazici M, Surat A. Atlantoaxial rotatory fixation-subluxation revisited: a computed tomographic analysis of acute torticollis in pediatric patients. Spine 2002;27:2771-2775.
crossref pmid
35. Maigne JY, Mutschler C, Doursounian L. Acute torticollis in an adolescent: case report and MRI study. Spine 2003;28:E13-15.
crossref pmid
36. Simsek S, Yigitkanli K, Kazanci A, Belen D, Bavbek M. Medically treated paravertebral Brucella abscess presenting with acute torticollis: case report. Surg Neurol 2007;67:207-210.
crossref pmid
37. Sankar J, Srinivasan A, Ramakrishnan V, Balasubramaniam C. An Unusual Cause of Acute Torticollis. Clin Pediatr (Phila) 2009.
crossref pdf
38. Papadimitriou NG, Christophoridis J, Papadimitriou A, Beslikas TA. Acute torticollis after isolated stress fracture of the first rib in a child. A case report. J Bone Joint Surg Am 2005;87:2537-2540.
crossref pmid
39. Mukherjee S, Sharief N. Bacterial meningitis presenting as acute torticollis. Acta Paediatr 2004;93:1005-1006.
crossref pmid


ABOUT
ARTICLE CATEGORY

Browse all articles >

ARCHIVES
FOR CONTRIBUTORS
Editorial Office
37 Ichon-ro 46-gil, Yongsan-gu, Seoul
Tel: +82-2-6350-6562    Fax: +82-2-792-5208    E-mail: jkmamaster@gmail.com                

Copyright © 2024 by Korean Medical Association.

Developed in M2PI

Close layer
prev next